title: procedure for managing stress in the workplace ... and... · the ccg recognises that...

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Title: Procedure for Managing Stress in the Workplace

Reference No: 029 HR

Owner: Chief Officer

Author Peter Smith, HR Business Partner, Ruth Nutbrown, Assistant Chief Officer.

First Issued On: December 2014

Latest Issue Date:

Operational Date: December 2014

Review Date: January 2020

Consultation Process OE and Staff Representatives Group

Ratified and approved by: Operational Executive January 2017

Distribution: All staff and GP members of the CCG.

Compliance: Mandatory for all permanent and temporary employees of Rotherham CCG.

Equality & Diversity Statement:

In applying this policy, the Organisation will have due regard for the need to eliminate unlawful discrimination, promote equality of opportunity, and provide for good relations between people of diverse groups, in particular on the grounds of the following characteristics protected by the Equality Act (2010); age, disability, gender, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, and sexual orientation, in addition to offending background, trade union membership, or any other personal characteristic.

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Contents

1. Purpose 2. Scope 3. Definition of stress 4. Roles and responsibilities

4.1 Manager responsibilities 4.2 Occupational Health employees responsibilities 4.3 Health and Safety Advisor responsibilities 4.4 Human Resources responsibilities 4.5 Employee responsibilities 4.6 Health and Safety Committee responsibilities

5. Risk Assessments 5.1 Hazards 5.2 Risk 5.3 Risk Assessment Process 5.4 Individual differences

6. References Appendices A. HSE Management Standards B. Possible Signs, Symptoms and Consequences of Stress C. Hints and Tips which may help people to cope better with stress D. CCG Risk Assessment Template E. Return to Work Questionnaire.

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1. Purpose NHS Rotherham CCG (the CCG) is committed to protecting the health, safety and wellbeing of its employees. The CCG recognises that workplace stress is a health and safety issue and acknowledges the importance of identifying and reducing workplace stressors (HSE 2016). The purpose of this procedure is to provide a framework and guidance to managers and employees for the effective prevention and management of stress at work. The CCG will develop working practices that reduce or prevent factors which may lead to stress in the workplace and identify support mechanisms in place for managing stress.

2. Scope This procedure will apply to all employees of the CCG.

3. Definition of stress The Health and Safety Executive (HSE) define stress as “the adverse reaction people have to excessive pressure or other types of demand placed on them”. This makes an important distinction between pressure, which can be a positive state if managed correctly, and stress which can be detrimental to health (HSE 2016). The HSE breaks down the term stress into 6 key areas or ‘potential primary’ stressors, these are: -

Demands: Includes issues like workload, work pattern and the work environment;

Control: Includes how much say the person has in the way in which they do their work;

Support: Includes the encouragement, sponsorship and resources provided by the CCG, line management and colleagues;

Relationships: Includes promoting positive working to avoid conflict and dealing with unacceptable behaviour;

Role: includes whether people understand their role within the CCG and whether the CCG ensures that the employee does not have conflicting roles;

Change: includes how the CCG and its line managers manage and communicate the change process.

(See Appendix A for further details) 4. Roles and Responsibilities

4.1 Line Managers responsibilities

Conduct and implement recommendations of risk assessments within their scope of responsibility.

Ensure good communication between management and employees, particularly where there are organisational and procedural changes.

Ensure employees are clear on their roles and are trained to undertake those roles effectively.

Monitor workloads to ensure that employees are not overloaded.

Monitor and address sickness absence in line with the CCG procedure and ensure that ‘return to work’ interviews are completed.

Monitor working hours and overtime to ensure that employees are not overworking.

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Monitor holidays to ensure that employees are taking their full entitlement.

Attend training as required in good management practice and health and safety.

Offer appropriate support following critical incidents

Help employees maintain a healthy work life balance, being perceptive and sensitive and offering appropriate support to members of employees who experience stress outside of work, e.g. bereavement or separation.

Encourage referrals to the employees counselling service or specialist agencies as required.

Conduct return to work meetings using the HSE Stress Management return to work questionnaire (appendix E)

4.2 Occupational Health responsibilities

Supporting individuals who have been off sick with stress and advising them and their managers on a planned return to work.

Encouraging referrals to employees counselling service or specialist agencies as required.

Contribute to monitoring and reviewing the effectiveness of measures to reduce stress.

Inform the CCG of any changes or developments in the field of stress.

4.3 Health & Safety Advisor responsibilities

Providing specialist advice and awareness training on stress

Training and supporting managers in implementing stress risk assessments.

Contributing to monitoring and reviewing the effectiveness of measures to reduce stress.

Informing the CCG of any changes or developments in the field of stress.

4.4 Human Resources responsibilities

Giving guidance to managers on this procedure.

Taking a lead role in monitoring the effectiveness of measures to address stress by for example co-ordinating the staff survey action plan, collating sickness absence statistics and identifying trends in information produced relating to the potential primary causes of stress.

Providing management and leadership development programmes and training that include training on recognising and managing stress for staff.

Provide continuing support to managers and individuals in a changing environment and encouraging referral to occupational health and the employees counselling service where appropriate.

Supporting managers in return to work meetings using the HSE Stress Management return to work questionnaire (Appendix E)

4.5 Employee responsibilities

Taking care of their own health and safety at work and others including maintaining and improving their own physical and mental health.

Helping to identify factors in departments which may cause excessive stress and discuss these with their manager.

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Raising issues of concern with line manager

Accepting opportunities for support where recommended and/or available.

4.6 Employee representatives – i.e. Trade Union or Staff side representatives)

Meaningfully consulted on changes to work practices or work design that could

precipitate stress.

Able to consult with members on issue of stress.

Meaningfully involved in the risk assessment process.

Involved in conducting joint inspections of the workplace to ensure that environmental stressors are properly controlled.

5. Risk Assessments The principles of risk assessment for stress are the same as for any other hazard. However, it is recognised that it may be more difficult for managers to identify psychological hazards. Refer to the CCG Risk Assessment template in Appendix D.

5.1 Hazards A hazard is anything that has the potential to cause harm, i.e., a stressor. The HSE have identified 6 potential primary causes of work related stress (i.e. stressors) which should be considered: • Demands • Control • Support • Relationships • Roles • Change

5.2 Risk A risk is the likelihood that someone may be harmed by a hazard that has been identified.

5.3 Risk Assessment Process The risk assessment process involves the following steps: 1. Identify / look for the hazards 2. Assess the risk to health, i.e. decide who might be harmed and how 3. Establish adequate control measures to reduce the risk to health 4. Record the significant findings of the assessment 5. Monitor the controls and periodically review the assessment

You may need to involve HR, Trade Union representatives or Health and Safety advisor for support in this process.

STEP 1 – Identify the Hazards 1. Examine existing data Information may exist which can assist in identifying if there is a potential problem, such as: Sickness absence data - review records of sickness absence and identify trends e.g. is this increasing; are patterns emerging; is stress cited as a reason for absence?

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Turnover data - review figures on employees’ turnover and identify trends Exit interviews - examine reasons given from employees for leaving Adverse incidents at work - is there an increase in incidents/ near misses? Reports of Harassment / Bullying / Grievances - incidence of such reports and is there a pattern in certain areas? Staff surveys - review the results of the annual NHS Employees Survey, which may help to identify areas of concern. Occupational health - has the occupational health department alerted you to any potential stress related issues affecting your employees and department?

2. Ask Employees Managers should involve employees in the risk assessment process by asking their help in identifying potential hazards. 3. Stressors Appendix A explains what stressors are and what measures can be taken to minimise these. STEP 2 – Assess the risks Having identified potential areas of harm, the next step is to identify who is at risk and ways of reducing the risk. STEP 3 – Implement Control Measures Control measures will vary depending on the risk identified. Some examples are:

Ensure all members of employees have job descriptions and understand their role

Ensure appraisals are undertaken, that objectives are set, and performance

monitored; identifying and addressing issues at an early stage.

Involve employees where possible in decision making

Identify training needs and provide support for these

Consider flexible working options where possible

Provide support to employees in coping mechanisms

STEP 4 – Monitoring Monitor control measures put in place and revise as necessary.

STEP 5 – Review Review the risk assessment. This could be reviewed according to the level of stress identified in the CCG and may be more frequent based on need.

5.4 Individual differences Although the risk assessment process takes a collective, proactive approach, it is recognised that individual differences exist and managers therefore need to take this into account in any assessments and discussions. Managers need to be familiar with where to go for help and what to do to help an individual if the need arises. Employees need to be encouraged to raise concerns and be informed of where they can go for help, such as HR or their Trade Union representative.

6. References

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The procedure has been developed with reference to Health and Safety Executive (HSE) publications which can be access via the HSE website www.hse.gov.uk. It has also being developed in partnership working with Staff side and employees are able to seek support if needed from their Trade Union representative.

http://www.hse.gov.uk/

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APPENDIX A HSE Management Standards The Management Standards approach has been developed by the Health and Safety Executive (HSE) to reduce the levels of work-related stress reported by British workers.

The standards and supporting processes are designed to:

Help risk assessment for stress

Encourage employers, employers and their representatives to work in partnership to address work – related stress throughout the organisation

Provide a yardstick by which organisation can gauge their performance in tackling the key causes of stress

The Management Standards define the characteristics, or culture, of an Organisation where stress is the being managed effectively. They are listed here and can also be found on www.hse.gov.uk/stress/standards along with a comprehensive tool kit. The Management Standards cover six key areas of work design that, if not properly managed are associated with poor health and wellbeing, lower productivity and increased sickness absence. In other words, the six Management Standards cover the primary sources of stress at work. These are:

1. Demands: Includes issues like workload, work patterns and the work environment The standard is that:

Employees indicate that they are able to cope with the demands of their jobs; and

Systems are in place locally to respond to any individual concerns.

What should be happening/states to be achieved?

The CCG provides employees with adequate and achievable demands in relation to the agreed hours of work;

People’s skills and abilities are matched to the job demands; Jobs are designed to be within the capabilities of employees; and

Employees’ concerns about their work environment are addressed.

2. Control: How much say the person has in the way they do their work The standard is that:

Employees indicate that they are able to have a say about the way they do their work; and



Where possible, employees have control over their pace of work;

Employees are encouraged to use their skills and initiative to do their work;

Where possible, employees are encouraged to develop new skills to help them undertake new and challenging pieces of work;

http://www.hse.gov.uk/stress/standards

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The CCG encourages employees to develop their skills;

Employees have a say over when breaks can be taken; and

Employees are consulted over their work patterns.

3. Support: Includes the encouragement, sponsorship and resources provided by the organisation, line management and colleagues The standard is that:

Employees indicate that they receive adequate information and support from their colleagues and superiors; and



The CCG has policies and procedures to adequately support employees;

Systems are in place to enable and encourage managers to support their employees;

Systems are in place to enable and encourage employees to support their colleagues;

Employees know what support is available and how and when to access it;

Employees know how to access the required resources to do their job; and

Employees receive regular and constructive feedback.

4. Relationships: Includes promoting positive working to avoid conflict and dealing with unacceptable behaviour

The standard is that:

Employees indicate that they are not subjected to unacceptable behaviours, e.g. bullying at work; and



The CCG promotes positive behaviours at work to avoid conflict and ensure fairness;

Employees share information relevant to their work;

The CCG has agreed policies and procedures to prevent or resolve unacceptable behaviour;

Systems are in place to enable and encourage managers to deal with unacceptable behaviour; and

Systems are in place to enable and encourage employees to report unacceptable behaviour.

5. Role: Whether people understand their role within the CCG and whether the CCG ensures that the person does not have conflicting roles


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Employees indicate that they understand their role and responsibilities; and



The CCG ensures that, as far as possible, the different requirements it places upon employees are compatible;

The CCG provides information to enable employees to understand their role and responsibilities;

The CCG ensures that, as far as possible, the requirements it places upon employees are clear; and

Systems are in place to enable employees to raise concerns about any uncertainties or conflicts they have in their role and responsibilities.

6. Change: How organisational change (large or small) is managed and communicated in the organisation


Employees indicate that the CCG engages them frequently when undergoing an organisational change; and



The CCG provides employees with timely information to enable them to understand the reasons for proposed changes;

The CCG ensures adequate employee consultation on changes and provides opportunities for employees to influence proposals;

Employees are aware of the probable impact of any changes to their jobs. If necessary, employees are given training to support any changes in their jobs;

Employees are aware of timetables for changes;

Employees have access to relevant support during changes.

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Appendix B Possible Signs, Symptoms and Consequences of Stress Signs and symptoms of stress vary from one individual to another. Some of the signs and symptoms may include the following:

Behavioural:

Short term Long term Over indulgence in smoking/alcohol/drugs Marital/family breakdown Impulsive behaviour/apathy Errors/accidents Poor interpersonal relationships Poor work performance/job loss

Physical: Please be aware. The physical symptoms below may be attributed to other conditions other than stress.

Short term Long term Headaches Heart disease Backaches Hypertension Disturbed sleep patterns/tiredness Ulcers Nausea/dizziness Poor general health Indigestion Insomnia Chest pain

Emotional:

Short term Long term Anxiety/depression Chronic depression & anxiety Lack of motivation Neurosis Difficulty in concentrating Mental breakdown Boredom Suicide Irritability Low self esteem Panic attacks

Possible consequences of stress in the workplace:

Reduced motivation & commitment to work

Reduced morale

Decreased productivity

Poor judgement

Reduced quality of patient care

Increase in errors and accidents

Tension & conflict between colleagues

Increased absenteeism

High employees turnover

Effects on home / family life

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Whole teams, department and organisations can suffer from stress in the same way as individuals do. This can result in “fight, flight or freeze” reactions. Information on this is also available from Breathe.

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Appendix C Hints & Tips Which May Help people to Cope Better with Stress In addition to support available from the occupational health department and Breathe, the following ideas may also help:

Rest & relaxation – learning to relax

Take a lunch break away from your work place

Exercise – take regular exercise.

Lifestyle – making time for leisure activities and interests

Talking – talking things through with friends or relatives can help

Take time to think – thinking time each day can help to manage time and priorities

Good health – eating sensibly, getting enough rest & avoiding harmful effects of alcohol and tobacco

Not being afraid to ask for help

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Appendix D

CCG Risk Assessment Template.

STRESS RISK ASSESSMENT

Name:

Date:

SOURCES OF STRESS

QUESTIONS TO ASK

YES/NO

Demands

Do you feel you have just the right amount of work to do (i.e. not too much or not too little)?

Have you had sufficient training to do your job?

Do you feel that you are working under excessive pressure?

Do you feel that there are inadequate resources for your tasks?

Do you feel that your work is boring or repetitive?

Is your workstation set up correctly?

Does the physical work environment have poor temperature control / Ventilation?

Is the work environment noisy?

Do you take the breaks you are entitled to at work?

Does the work environment have sufficient lighting?

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Does your facility have adequate facilities for rest / breaks?

Control

Are you able to have any say about how your job is done?

Do you feel included in decision making in the team?

Do you have fixed deadlines occurring in different parts of the week / month / year?

Do you have rigid work patterns?

Do you have any control over work?

Do you have conflicting work demands?

Do you feel you are using the skills you have got to full effect?

Are you able to balance the demands of work and life outside work?

Support

Do you feel that you get enough support from your line manager?

Do you feel you get enough support from colleagues?

Relationships

Are you affected by any conflict in the team?

Are you subjected to any bullying or harassment at work?

Have you suffered from any verbal abuse while at work?

Do you feel the team works well together?

Are there any personal factors occurring at home which may have an impact on your work?

Role

Are you clear about your roles and responsibilities at work?

Do you feel that there is an expectation that people will regularly work excessively long hours or take home with them?

Do you feel that there is a culture that considers stress a sign of weakness?

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Do you feel that there is any conflict in your role?

Do you feel that there is a blame culture when things go wrong or a denial of potential problems?

Do you understand others roles in the team?

Change

Are you made aware of any changes that are happening at work?

Do you understand why the change is happening?

Do you understand the impact on your job of any change?

Do you feel well supported during change at work?

Do you have any concerns about job security?

When the stress risk assessment has been completed, develop an action plan (attached) to address any areas of concern this action plan should be reviewed on a regular basis.

STRESS RISK ASSESSMENT FORM

Risk assessment for: ………………………………………………. Location / Team…………………………………….. Manager…………………………………….. Date………………….

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Type of Stressor

Specific causes of workplace stress identified within each category

Existing workplace precautions already

in place

Further action to be taken

Who will ensure the action is done? and

Review date

Demands

Control

Support

Type of Stressor

Specific causes of workplace stress identified within each category

Existing workplace precautions already

in place

Further action to be taken

Who will ensure the action is done? and

Review date

Relationships

Role

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Change

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Appendix E

Return to work questionnaire

Cause of stress

Question Was it a problem for you?

Use this space to detail what the problem was. If it was not a problem leave it blank

What can be done about it?

Can we make any adjustments?

Demands Did different people at work demand things from you that were hard to combine?

Did you have unachievable deadlines?

Did you have to work very intensively?

Did you have to neglect some tasks because you had too much to do?

Were you unable to take sufficient breaks?

Did you feel pressured to work long hours?

Did you feel you had to work very fast?

Did you have unrealistic time pressures?

Control Could you decide when to take a break?

Did you feel you had a say in your work speed?

Did you feel you had a choice in deciding how you did your work?

Did you feel you had a choice in deciding what you did at work?

Did you feel you had some say over the way you did your work?

Did you feel your time could be flexible?

Support* (Manager)

Did your manager give you enough supportive feedback on the work you did?

Did you feel you could rely on your manager to help you with a work problem?

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Did you feel you could talk to your manager about something that upset or annoyed you at work?

Support* (Manager)

Did you feel your manager supported you through any emotionally demanding work?

Did you feel your manager encouraged you enough at work?

(Peers) Did you feel your colleagues would help you if work became difficult?

Did you get the help and support you needed from your colleagues?

Did you get the respect at work you deserved from your colleagues?

Were your colleagues willing to listen to your work-related problems?

Relationships* Were you personally harassed, in the form of unkind words or behaviour?

Did you feel there was friction or anger between colleagues?

Were you bullied at work?

Were relationships strained at work?

Role Were you clear about what was expected of you at work?

Did you know how to go about getting your job done?

Were you clear about what your duties and responsibilities were?

Were you clear about the goals and objectives for this department?

Did you understand how your work fits into the overall aim of the organisation?

Change Did you have enough opportunities to question managers about change at work?

Did you feel consulted about change at work?

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When changes were made at work, were you clear about how they would work out in practice?

Other issues Is there anything else that was a source of stress for you, at work or at home, that may have contributed to you going off work with work-related stress?

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Factors outside work This list of questions on return to work has mainly focused on factors at work. However, there

may be factors outside work, for example in your family life, which may have contributed to or added to the pressures at work. These may have made it harder to cope with demands at work that you would normally be able to cope with.

You may want to share these issues with your manager – they may be able to help at work

and make adjustments, for example, being more flexible with working hours or just being sympathetic to the pressures you are under.

If you do not feel happy telling your manager about these things, is there anyone else you can turn to, for example, your human resources department or employee assistance programmes at work? You may also like to look at the links at http://www.hse.gov.uk/stress/links.htm on the

http://www.hse.gov.uk/stress/links.htm

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